SEATTLE ROOTS COMMUNITY HEALTH: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
SEATTLE ROOTS COMMUNITY HEALTH (EIN 23-7100868)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-08-24
IRS object ID
201102369349300135
Schema version
2010v3.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-08-24T18:26:32-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line13000 NORTHUP WAY SUITE 200AddressLine1
CityBELLEVUECity
StateWAState
ZIP Code980041446ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237100868EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COUNTRY DOCTOR COMMUNITY CLINICBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOUNNameControl
Phone2062991937Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12101 EAST YESLER WAY NO 210AddressLine1
CitySEATTLECity
StateWAState
ZIP Code981225900ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLINDA MCVEIGHName
TitleEXECUTIVE DIRECTORTitle
Phone2062991937Phone
Date Signed2011-07-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NamePAUL M BAILEYName
Phone4252506100Phone
Date Prepared2011-07-13DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonLINDA MCVEIGHNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1500 19TH AVENUE EASTAddressLine1
CitySEATTLECity
StateWAState
ZIP Code98112ZIPCode
FieldValueIRS element (for citing)
Gross Receipts13702447GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.COUNTRYDOCTOR.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1971YearFormation
State Legal DomicileWAStateLegalDomicile
Activity Or Mission DescriptionTHE MISSION OF COUNTRY DOCTOR COMMUNITY CLINIC IS TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING HIGH QUALITY, CARING, CULTURALLY APPROPRIATE PRIMARY HEALTH CARE THAT ADDRESSESS THE NEEDS OF PEOPLE REGARDLESS OF THEIR ABILITY TO PAY.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees162TotalNbrEmployees
Total Nbr Volunteers16TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year4928394ContributionsGrantsPriorYear
Contributions Grants Current Year5556179ContributionsGrantsCurrentYear
Program Service Revenue Prior Year5288616ProgramServiceRevenuePriorYear
Program Service Revenue CY5616085ProgramServiceRevenueCY
Investment Income Prior Year143487InvestmentIncomePriorYear
Investment Income Current Year60346InvestmentIncomeCurrentYear
Other Revenue Prior Year165142OtherRevenuePriorYear
Other Revenue Current Year136860OtherRevenueCurrentYear
Total Revenue Prior Year10525639TotalRevenuePriorYear
Total Revenue Current Year11369470TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year7647229SalariesEtcPriorYear
Salaries Etc Current Year7969816SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year137543TotalFundrsngExpCurrentYear
Other Expense Prior Year2968411OtherExpensePriorYear
Other Expenses Current Year3475088OtherExpensesCurrentYear
Total Expenses Prior Year10615640TotalExpensesPriorYear
Total Expenses Current Year11444904TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-90001RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-75434RevenuesLessExpensesCY
Total Assets BOY7508424TotalAssetsBOY
Total Assets EOY7442954TotalAssetsEOY
Total Liabilities BOY3008310TotalLiabilitiesBOY
Total Liabilities EOY2998470TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4500114NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4444484NetAssetsOrFundBalancesEOY
Mission DescriptionTHE MISSION OF COUNTRY DOCTOR COMMUNITY CLINIC IS TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING HIGH QUALITY, CARING, CULTURALLY APPROPRIATE PRIMARY HEALTH CARE THAT ADDRESSESS THE NEEDS OF PEOPLE REGARDLESS OF THEIR ABILITY TO PAY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense7562636Expense
Revenue5288616Revenue
DescriptionIN 2010 COUNTRY DOCTOR COMMUNITY CLINIC PROVIDED 49,961 MEDICAL VISITS. 92% OF THE PATIENTS SEEN IN 2010 HAD INCOME LESS THAN 200% OF THE FEDERAL POVERTY LEVEL (FPL). ALL UNINSURED PATIENTS (60% OF THE TOTAL PATIENTS SEEN) EARNING LESS THAN 200% OF FPL WERE SEEN ON A SLIDING SCALE DISCOUNT. THE CARE PROVIDED UNDER THIS POLICY TOTALED $2,050,725 IN 2010.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense236628Expense
DescriptionDENTAL CARE IS PROVIDED TO COUNTRY DOCTOR COMMUNITY CLINIC (CDCC) PATIENTS THROUGH A CONTRACTUAL ARRANGEMENT WITH A COMMUNITY DENTAL PROVIDER. IN 2010, 4,039 DENTAL VISITS WERE PROVIDED TO LOW INCOME, UNINSURED PATIENTS. THERE IS NO REVENUE GENERATED BY CDCC THROUGH THIS CONTRACT.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense803013Expense
DescriptionTHE OTHER HEALTH SERVICES PROGRAM PROVIDED 16,625 ANCILLARY HEALTH VISITS (EG NUTRITION, MENTAL HEALTH, WIC) TO LOW INCOME PATIENTS.Description
FieldValueIRS element (for citing)
Total Program Service Expense8602277TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10961NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees162NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledWAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SUSANA TANTICOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2062991937TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12101 EAST YESLER WAY SUITE 210AddressLine1
CitySEATTLECity
StateWAState
ZIP Code98122ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
ADRIENE OWENS
DIRECTOR1.00X000
ALISON ALLGOR
VICE CHAIRPERSON1.00X000X
AUGUST PIPER
DIRECTOR1.00X000
CINDY GRANGER
DIRECTOR1.00X000
CHERYL ANDERSON
DIRECTOR1.00X000
JERRY SALE
TREASURER1.00X000X
JOAN KLEINBERG
SECRETARY1.00X000X
LY SIENG NGO
DIRECTOR1.00X000
PAMELA DUNN
DIRECTOR1.00X000
PATRICK FERGUSON
DIRECTOR1.00X000
ROBERT LESKO
DIRECTOR1.00X000
ROBERT STRAIT
DIRECTOR1.00X000
SHEILA BURROUGHS
CHAIRPERSON1.00X000X
SARA THOMPSON
DIRECTOR1.00X000
WINNIE SPERRY
DIRECTOR1.00X000
LINDA MCVEIGH
EXECUTIVE DIRECTOR35.00140012013558X
SUSANA TANTICO
DIRECTOR OF FINANCE40.0083731010603X
RICHARD KOVAR MD
MEDICAL DIRECTOR32.00159614017045X
HAROLD MOORE
PHYSICIAN/SITE DIRECTOR35.00140329013451X
CARRIE RUBENSTEIN MD
PHYSICIAN/CLINICAL DIRECTOR28.00108822010982X
MEGAN DEBELL MD
PHYSICIAN/CLINICAL DIRECTOR28.00106032010096X
BESSIE CHI
PHARMACIST40.00110205012143X
BRADLEY ROTER MD
PHYSICIAN24.50105055012357X
FieldValueIRS element (for citing)
Total Reportable Comp From Org953800TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation100235TotalOtherCompensation
Number Individuals GT100 K7NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1PTSO OF WASHINGTONBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1710 OLIVE WAY SUITE 300AddressLine1
CitySEATTLECity
StateWAState
ZIP Code98101ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesINFO TECH SUPPORTDescriptionOfServices
Compensation274796Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Federated Campaigns120855FederatedCampaigns
Fundraising Events98010FundraisingEvents
Government Grants4733470GovernmentGrants
All Other Contributions603844AllOtherContributions
Total Contributions5556179TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
THIRD PARTY PAYMENTS90009920832212083221
PATIENT FEES62140019526491952649
MEDICARE/MEDICAID PAYM90009915802151580215
FieldValueIRS element (for citing)
Total Program Service Revenue5616085TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column28671TotalRevenueColumn
Exclusion$28,671ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real55997Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real55997Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column55997TotalRevenueColumn
Exclusion$55,997ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities2329611Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities2297936Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities31675Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column31675TotalRevenueColumn
Exclusion$31,675ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events34051GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events98010CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses35041FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-990TotalRevenueColumn
Exclusion-$990ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER REVENUEDescription
Business Code900099BusinessCode
Total Revenue Column81853TotalRevenueColumn
Related Or Exempt Function Income81853RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue81853TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column11369470TotalRevenueColumn
Related Or Exempt Function Income5697938RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$115,353ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total383047Total
Program Services159517ProgramServices
Management And General223530ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5931624Total
Program Services4622333ProgramServices
Management And General1229387ManagementAndGeneral
Fundraising79904Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total245809Total
Program Services190011ProgramServices
Management And General51996ManagementAndGeneral
Fundraising3802Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total955225Total
Program Services695614ProgramServices
Management And General250034ManagementAndGeneral
Fundraising9577Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total454111Total
Program Services342029ProgramServices
Management And General105969ManagementAndGeneral
Fundraising6113Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total6405Total
Management And General6405ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total81644Total
Management And General81644ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total949079Total
Program Services708414ProgramServices
Management And General240569ManagementAndGeneral
Fundraising96Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total386024Total
Program Services287353ProgramServices
Management And General80842ManagementAndGeneral
Fundraising17829Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total439999Total
Program Services230634ProgramServices
Management And General202339ManagementAndGeneral
Fundraising7026Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total54304Total
Program Services32709ProgramServices
Management And General20816ManagementAndGeneral
Fundraising779Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total454816Total
Program Services387124ProgramServices
Management And General67090ManagementAndGeneral
Fundraising602Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total78759Total
Program Services8616ProgramServices
Management And General70143ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
PHARMACEUTICALS438296438296
BAD DEBT385889385889
MISCELLANEOUS1998731137387432011815

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total11444904Total
Program Services8602277ProgramServices
Management And General2705084ManagementAndGeneral
Fundraising137543Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY446267BOY
EOY635067EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY404915BOY
EOY91346EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1098490BOY
EOY712067EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY442008BOY
EOY498992EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY316619BOY
EOY342872EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis7535087LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4273845LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2750208BOY
EOY3261242EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY2049917BOY
EOY1887283EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY0BOY
EOY14085EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7508424BOY
EOY7442954EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY918688BOY
EOY959032EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1751593BOY
EOY1724290EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY338029BOY
EOY315148EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3008310BOY
EOY2998470EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4355685BOY
EOY4361429EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY61374BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY83055BOY
EOY83055EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4500114BOY
EOY4444484EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7508424BOY
EOY7442954EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-75434ReconcilationRevenueExpenses
Reconcilation Other Changes19803ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3826675CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3939346CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4565967CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4928394CurrentTaxYearMinus1Year
Current Tax Year5556179CurrentTaxYear
Total22816561Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3826675CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3939346CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4565967CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4928394CurrentTaxYearMinus1Year
Current Tax Year5556179CurrentTaxYear
Total22816561Total
FieldValueIRS element (for citing)
Public Support Total17022816561PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years136949CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years171525CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years134216CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year95365CurrentTaxYearMinus1Year
Current Tax Year84668CurrentTaxYear
Total622723Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years140611CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years94785CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year74227CurrentTaxYearMinus1Year
Current Tax Year30685CurrentTaxYear
Total340308Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2633CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3939CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1882CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3841CurrentTaxYearMinus1Year
Total12295Total
FieldValueIRS element (for citing)
Total Support23791887TotalSupport
Public Support Pertcentage1700.95900PublicSupportPertcentage170
Public Support Pertcent Prior Year0.95670PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance83055BeginningOfYearBalance
End Of Year Balance83055EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance83055BeginningOfYearBalance
End Of Year Balance83055EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance83055BeginningOfYearBalance
End Of Year Balance83055EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis184000OtherCostOrOtherBasis
Book Value184000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4621348OtherCostOrOtherBasis
Depreciation2805654Depreciation
Book Value1815694BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis182047OtherCostOrOtherBasis
Depreciation171363Depreciation
Book Value10684BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1807067OtherCostOrOtherBasis
Depreciation1296828Depreciation
Book Value510239BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis740625OtherCostOrOtherBasis
Book Value740625BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings3261242TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
CAPITAL LEASE$28,015
FQHC ENHANCEMENT SETTLEMENT$287,133
FieldValueIRS element (for citing)
Total Of Amounts315148TotalOfAmounts
Total Revenue11369470TotalRevenue
Total Expenses11444904TotalExpenses
Excess Or Deficit For Year-75434ExcessOrDeficitForYear
Net Unrealized GL On Investments-15899NetUnrealizedGLOnInvestments
Donated Services And Facilities35702DonatedServicesAndFacilities
Total Adjustments19803TotalAdjustments
Excess Or Deficit Per FS-55631ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt11424314TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-15899NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities35702DonatedSrvcAndUseOfFacilities
Revenue Not Rptd F99019803RevenueNotRptdF990
Revenue Subtotal11404511RevenueSubtotal
Other Revenues Not Included-35041OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-35041RevenueNotRptdOnFinStmt
Total Revenue Per Form99011369470TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt11479944TotExpensesEtcAuditedFinclStmt
Other Expenses Included35041OtherExpensesIncluded
Expenses Not Rptd F99035041ExpensesNotRptdF990
Expenses Subtotal11444903ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99011444903TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:THE ENDOWMENT FUNDS ARE ASSETS SET ASIDE AND RESTRICTED BY DONORS. THE INCOME GENERATED FROM THESE ASSETS IS USED TO FUND OPERATIONS OF THE ORGANIZATION.
PART XII, LINE 4B - OTHER ADJUSTMENTS: DIRECT SPECIAL EVENT EXPENSES PART XIII, LINE 2D - OTHER ADJUSTMENTS: DIRECT SPECIAL EVENT EXPENSES

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1DINNERNameOfEvent1
Gross Receipts Event1132061GrossReceiptsEvent1
Charitable Contributions Event198010CharitableContributionsEvent1
Gross Revenue Event134051GrossRevenueEvent1
Non Cash Prizes Event13000NonCashPrizesEvent1
Rent Facility Costs Event16168RentFacilityCostsEvent1
Food And Beverage Event120543FoodAndBeverageEvent1
Entertainment Event11000EntertainmentEvent1
Other Direct Expenses Event14330OtherDirectExpensesEvent1
Gross Receipts Total132061GrossReceiptsTotal
Charitable Contributions Total98010CharitableContributionsTotal
Gross Revenue Total Events34051GrossRevenueTotalEvents
Non Cash Prizes Total Events3000NonCashPrizesTotalEvents
Rent Facility Costs Total Events6168RentFacilityCostsTotalEvents
Food And Beverage Total Events20543FoodAndBeverageTotalEvents
Entertainment Total Events1000EntertainmentTotalEvents
Other Direct Expenses Total Events4330OtherDirectExpensesTotalEvents
Direct Expense Summary Events35041DirectExpenseSummaryEvents
Net Income Summary-990NetIncomeSummary

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
LINDA MCVEIGH
139904010800000135580153570000
RICHARD KOVAR MD
15951709700000170450176659000
HAROLD MOORE
140221010800000134510153780000

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions12NumberOfContributions
Noncash Contribs Rptd F990250296NoncashContribsRptdF990
Method Of Determining RevenuesCOST OR SELLING PRICEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Number Of8283 Received0NumberOf8283Received
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII

FieldValueIRS element (for citing)
IdentifierMETHOD FOR DETERMINING NUMBER OF CONTRIBUTORS:Identifier
Return ReferencePART I, COLUMN (B):ReturnReference
ExplanationCDCHC RECEIVES VACCINES AND PHARMACEUTICALS THAT ARE DISPENSED TO PATIENTS, DONATIONS OF VARYING AMOUNTS ARE RECEIVED AT LEAST MONTHLY THROUGHOUT THE YEAR.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11THE EXECUTIVE DIRECTOR AND DIRECTOR OF FINANCE BOTH REVIEW A DRAFT OF THE RETURN BEFORE IT IS PRESENTED TO THE FINANCE COMMITTEE FOR FURTHER REVIEW. AFTER REVIEW BY THE FINANCE COMMITTEE AND DISTRIBUTION TO THE FULL BOARD THE FORM 990 IS FILED WITH THE IRS.
COMPLIANCE AND NON-COMPLIANCE WERE REGULARLY AND CONSISTENTLY MONITORED AND ENFORCED DURING THE MONTHLY MEETING. BOARD MEMBERS SIGN A CONFLICT OF INTEREST FORM ANNUALLY. ANY MEMBER WITH A STATED CONFLICT OF INTEREST IS REVIEWED BY THE EXECUTIVE COMMITTEE. THE BOARD CHAIRPERSON DETERMINES THE EXTENT OF THE CONFLICT AND WHETHER THE CONFLICTED BOARD MEMBER SHOULD NOT VOTE ON AN ISSUE OR SHOULD RECUSE THEMSELF FROM THE DISCUSSION.FORM 990, PART VI, SECTION B, LINE 12C
THE EXECUTIVE DIRECTOR'S COMPENSATION IS REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS. EVERY TWO YEARS THIS PROCESS IS ASSISTED BY AN INDEPENDENT COMPENSATION CONSULTANT. THE LAST REVIEW PROCESS OF THE EXECUTIVE DIRECTOR'S COMPENSATION WAS DONE IN AUGUST 2010. THE DIRECTOR OF FINANCE'S COMPENSATION IS DETERMINED ANNUALLY BY THE BOARD BASED ON A MILLIMAN SURVEY THAT ASSESSES MARKET COMPENSATION. THE REVIEW OF THE DIRECTOR OF FINANCE'S COMPENSATION WAS DONE IN JULY 2010.FORM 990, PART VI, SECTION B, LINE 15
NO DOCUMENTS AVAILABLE TO THE PUBLIC.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED LOSSES ON INVESTMENTS: -15,899. DONATED SERVICES AND USE OF FACILITIES: 35,702. TOTAL TO FORM 990, PART XI, LINE 5: 19,803.FORM 990, PART XI, LINE 5:
PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.PART XII, LINE 2C

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